Abstract:

Objective　To analyze the efficacy and mechanism of Xiaoxuming decoction combined with conventional western medicine in the treatment of patients with acute ischemic stroke of wind-fire disturbance type. Methods　One hundred and eighty-eight patients with acute ischemic stroke of wind-fire disturbance syndrome type treated at Shangluo Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were selected for the randomized controlled trial. They were divided into a control group and a study group by the random number table method, with 94 cases in each group. There were 48 males and 46 females in the control group; they were (67.50±6.23) years old; their disease course was (7.21±1.15) h; 58 cases had lesions in basal ganglia, 27 cases brains, and 9 cases cerebellums. There were 49 males and 45 females in the study group; they were (67.00±8.46) years old; their disease course was (7.14±1.04) h; 59 cases had lesions in basal ganglia, 25 cases brains, and 10 cases cerebellums. The control group were treated with conventional western medicine, and the study group with Xiaoxuming decoction and conventional western medicine, for 28 d. The traditional Chinese medicine (TCM) symptom scores, scores of National Institute of Health Stroke Scale (NIHSS), and Barthel index scores before the treatment and after 28 days' treatment and the clinical efficacies were compared between the two groups. The levels of serum glial fibrillary acidic protein (GFAP), stromal cell-derived factor (SDF-1), brain-derived neurotrophic factor (BDNF), monocyte chemoattractant protein-1 (MCP-1), homocysteine (Hcy), C-reactive protein (CRP), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA), blood viscosity, fibrinogen (FIB), and D-dimer (D-D) before and after the treatment were compared. The safety during the treatment was compared. t test, χ² test, and rank sum test were used. Results　After 28 days' treatment, the TCM symptom scores [(13.00±2.64) and (9.50±1.71)], NIHSS scores [(9.50±1.76) and (6.00±1.21)] and levels of GFAP [(5.02±1.25) μg/L and (4.21±0.98) μg/L], MCP-1[(112.28±10.29) μg/L and (92.58±7.41) μg/L], Hcy [(15.25±2.67) μmol/L and (8.56±2.21) μmol/L], CRP [(10.50±2.12) mg/L and (6.89±1.24) mg/L], MDA [(7.58±1.05) mol/L and (5.42±1.12) mol/L], whole blood high shear viscosity [(4.85±1.23) mPa/s and (2.58±1.05) mPa/s], whole blood low shear viscosity [(16.45±3.56) mPa/s and (10.89±1.98) mPa/s], plasma viscosity [(1.56±0.19) mPa/s and (1.35±0.15) mPa/s], FIB [(3.25±0.47) g/L and (2.68±0.35) g/L], and D-D [(1.91±0.29) mg/L and (1.39±0.26) mg/L] in the control group and the study group were lower than those before the treatment (all P<0.001), and those in the study group were lower than those in the control group (all P<0.001). After the treatment, the Barthel index scores [(65.00±9.35) and (74.50±8.76)] and serum levels of SDF-1 [(502.94±29.32) μg/L and (550.75±30.56) μg/L], BDNF [(4.52±0.61) μg/L and (5.68±0.55) μg/L], SOD [(5.13±0.65) U/ml and (6.56±0.38) U/ml], and GSH PX [(34.32±6.87) mmol/L and (45.21±7.59) mmol/L] in the control group and the study group were higher than those before the treatment (all P<0.001), and those in the study group were higher those in the control group (all P<0.001). The total effective rate of the study group was higher than that of the control group [93.62% (88/94) vs. 75.53% (71/94); χ²=11.783, P<0.001]. There was no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Xiaoxuming decoction combined with conventional western medicine in the treatment of patients with acute ischemic stroke patients of wind-fire disturbance type can significantly improve their conditions and living abilities, and has significant curative effect and good safety.

Key words:

Xiaoxuming decoction, Acute ischemic stroke, Wind-fire disturbance type, Oxidative stress reaction, Hemorheology, Stromal cell derived factor

摘要：

目的　探讨小续命汤联合常规西医治疗风火上扰型急性缺血性脑卒中的疗效与作用机制。方法　前瞻性选取2020年1月至2022年1月商洛市中医医院收治的188例风火上扰型急性缺血性脑卒中患者，采用随机数字表法分为对照组与研究组。对照组94例，男48例、女46例，年龄（67.50±6.23）岁，病程（7.21±1.15）h，基底节、大脑、小脑病变分别为58、27、9例；研究组94例，男49例、女45例，年龄（67.00±8.46）岁，病程（7.14±1.04）h，基底节、大脑、小脑病变分别为59、25、10例。对照组给予常规西医治疗，研究组给予小续命汤联合常规西医治疗，均连续治疗28 d。对比治疗前与治疗28 d后的中医症状积分、美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数评分以及临床疗效，治疗前后血清胶质纤维酸性蛋白（GFAP）、基质细胞衍生因子（SDF-1）、脑源性神经营养因子（BDNF）、单核细胞趋化蛋白-1（MCP-1）、同型半胱氨酸（Hcy）、C反应蛋白（CRP）、过氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）、血液黏度、纤维蛋白原（FIB）、D-二聚体（D-D）水平变化情况及治疗期间的安全性。采用t检验、χ²检验、秩和检验进行统计分析。结果　治疗28 d后，对照组和研究组中医症状积分［（13.00±2.64）分、（9.50±1.71）分］、NIHSS评分［（9.50±1.76）分、（6.00±1.21）分］及GFAP［（5.02±1.25）μg/L、（4.21±0.98）μg/L］、MCP-1［（112.28±10.29）μg/L、（92.58±7.41）μg/L］、Hcy［（15.25±2.67）μmol/L、（8.56±2.21）μmol/L］、CRP［（10.50±2.12）mg/L、（6.89±1.24）mg/L］、MDA［（7.58±1.05）mol/L、（5.42±1.12）mol/L］、全血高切黏度［（4.85±1.23）mPa/s、（2.58±1.05）mPa/s］、全血低切黏度［（16.45±3.56）mPa/s、（10.89±1.98）mPa/s］、血浆黏度［（1.56±0.19）mPa/s、（1.35±0.15）mPa/s］、FIB［（3.25±0.47）g/L、（2.68±0.35）g/L］、D-D［（1.91±0.29）mg/L、（1.39±0.26）mg/L］均低于治疗前（均P<0.001），且研究组更低（均P<0.001）；对照组和研究组Barthel指数评分［（65.00±9.35）分、（74.50±8.76）分］及SDF-1［（502.94±29.32）μg/L、（550.75±30.56）μg/L］、BDNF［（4.52±0.61）μg/L、（5.68±0.55）μg/L］、SOD［（5.13±0.65）U/ml、（6.56±0.38）U/ml］、GSH-Px［（34.32±6.87）mmol/L、（45.21±7.59）mmol/L］水平均高于治疗前（均P<0.001），且研究组更高（均P<0.001）；研究组总有效率（93.62%，88/94）高于对照组（75.53%，71/94）（χ²=11.783，P=0.001）；两组不良反应发生率相当（P>0.05）。结论　小续命汤联合常规西医治疗风火上扰型急性缺血性脑卒中患者，可明显改善病情，提升生活能力，疗效显著，且安全性良好。

关键词:

小续命汤, 急性缺血性脑卒中, 风火上饶型, 氧化应激反应, 血液流变学, 基质细胞衍生因子